CT脑中线移位对恶性大脑中动脉梗塞去颅瓣减压术预后评估

Value of brain midline shift on CT on prognosis assessment of malignant middle cerebral artery infarction following decompressive hemicraniectomy

目的通过脑中线移位程度分析判定恶性大脑中动脉梗塞(MMI)去颅瓣减压术的疗效。方法回顾性分析37例行去颅瓣减压术治疗的MMI患者临床及非增强CT(NECT)影像资料。分析患者临床预后与手术前后NECT图像中线移位程度(减轻,无变化,增加)有无相关性。结果手术3个月后随访:预后不良17例(中线移位程度减轻3例、无变化5例、加重9例);预后良好20例(中线移位程度减轻12例、无变化2例、加重6例);经对比分析预后与手术前后中线移位程度减轻差异有统计学意义(χ2=6. 973,P=0. 039)。结论 CT中线移位程度可以预测MMI去颅瓣减压术后疗效。

Objective The therapeutic effect of decompressive hemicraniectomy in patients with malignant cerebral infarction was evaluated by the analysis of degree of the midline shift. Methods Clinical and non-enhanced CT imaging data of thirty-seven patients who underwent decompressive hemicraniectomy for MMI were studied,retrospectively. Whether there was a correlation between the clinical prognosis of patients and pre-operative and postoperative midline shift degree（reduction,no change,progression） were analyzed. Results Seventeen patients were poor prognosis after follow-up（3 months）,including 3 patients with midline shift reductions,5 patients without change and 9 patients with midline shift progression. And twenty patients were favorable prognosis after follow-up（3 months）,including 12 patients with midline shift reductions,2 patients without midline shift change and 6 patients with midline shift progression. The statistically significant difference was showed in prognosis and midline shift changes by the chi square test（χ^2= 6. 973,P = 0. 039）. Conclusion The midline shift on CT can predict the therapeutic effect of decompressive hemicraniectomy for patients with MMI.